Provider Demographics
NPI:1861168221
Name:KNOLLE, MARY ANNE (PHD)
Entity type:Individual
Prefix:DR
First Name:MARY
Middle Name:ANNE
Last Name:KNOLLE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:MARY
Other - Middle Name:ANNE
Other - Last Name:ERICSON-KNOLLE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:9912 CRESTRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76207-5616
Mailing Address - Country:US
Mailing Address - Phone:713-927-4217
Mailing Address - Fax:
Practice Address - Street 1:9912 CRESTRIDGE DR
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76207-5616
Practice Address - Country:US
Practice Address - Phone:713-927-4217
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-17
Last Update Date:2021-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10487101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty